{"id":2158,"date":"2024-11-10T21:11:24","date_gmt":"2024-11-11T02:11:24","guid":{"rendered":"https:\/\/wordpress.forensicpath.us\/?p=2158"},"modified":"2024-11-10T21:11:24","modified_gmt":"2024-11-11T02:11:24","slug":"pathology-cases-aspiration-of-blood","status":"publish","type":"post","link":"https:\/\/wordpress.forensicpath.us\/index.php\/2024\/11\/10\/pathology-cases-aspiration-of-blood\/","title":{"rendered":"Pathology cases: Aspiration of blood"},"content":{"rendered":"

This is the case of a man who was shot in the chest.\u00a0 At autopsy, the bullet perforated the left lung, and there was a left hemothorax of around 1400 cc.\u00a0 At autopsy, both lungs were hyperinflated.<\/p>\n

Here are pictures showing the entrance and exit through the left lung:<\/p>\n

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Here’s a slice through the left lung showing the disruption and diffuse hemorrhage along the path of the bullet:<\/p>\n

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The right lung was also hyperinflated, but had a pattern of hemorrhage on cut surface that is characteristic of aspiration of blood.\u00a0 Aspiration of blood results in collection of blood into alveoli where it fills lobules.\u00a0 This results in little dots of blood scattered throughout the lung:<\/p>\n

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There are a million reasons why there might be blood in the lungs, and a thousand different patterns for it.\u00a0 This punctate pattern, however, is suggestive of aspiration.\u00a0 I’ve seen a similar pattern with a vasculitis, and something a *little* like this in a case where someone was showering their lungs with small thromboemboli.\u00a0 It’s not only lung injury that provides this, of course.\u00a0 I see it more often in my practice in gunshot wounds to the head in which death is not rapid and blood drains from the cranium into the mouth, where it is inhaled and swallowed. With aspiration of blood you usually (though not always) see blood in the stomach as well.\u00a0 In this case there was relatively little blood in the upper trachea and oropharynx, which is often also blood stained in head wounds resulting in aspiration.<\/p>\n

Sometimes in cases like these you will be asked to opine about time until death.\u00a0 You know that the death was not immediate.\u00a0 The presence of 1.4 liters of blood in the left chest and scene evidence of substantial bleeding at the scene indicates a classic amount of hemorrhage associated with exsanguination.\u00a0 In general, the heart stops beating when you lose around 40% of your blood volume, which in most folk is 1500-2000cc.\u00a0 Most articles suggest unconsciousness at about 1400cc and death around 2000cc, but in my experience, we usually get 1400+ cc from the body.\u00a0 That’s not surprising, since significant blood can be left at the scene or otherwise not harvested.\u00a0 For a clinical evaluation of the relationship between blood loss and unconsciousness and death, see: Gutierrez, G., Reines, H. and Wulf-Gutierrez, M.E., 2004. Clinical review: hemorrhagic shock.\u00a0Critical care<\/i>,\u00a08<\/i>, pp.1-9.\u00a0 Of course, in some cases, such as gunshot wounds where there his no space for blood to collect, you might not see much at all.\u00a0 I recently had a case of a gunshot wound that severed the femoral artery in which almost all of the blood was left at the scene.<\/p>\n

The problem is that the rate of bleeding is a function of the size of the hole, the size of the vessel, and the health status of the decedent.\u00a0 So, you can say it was not immediate, but you really don’t know how long it took.\u00a0 More important, you certainly don’t know the time until unconsciousness.\u00a0 A victim may collapse immediately due to the autonomic effects of the trauma, or may struggle for some time.\u00a0 Be cautious.<\/p>\n

Also be aware that estimating blood volume by looking at the rug or a floor is fraught with danger of significant error.\u00a0 Be very careful and know your literature before you attempt that.<\/p>\n","protected":false},"excerpt":{"rendered":"

This is the case of a man who was shot in the chest.\u00a0 At autopsy, the bullet perforated the left…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[109],"tags":[59,118,65,28],"class_list":["post-2158","post","type-post","status-publish","format-standard","hentry","category-pathology-cases","tag-autopsy","tag-gunshot-wound","tag-lung","tag-pathology"],"_links":{"self":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2158","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/comments?post=2158"}],"version-history":[{"count":1,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2158\/revisions"}],"predecessor-version":[{"id":2163,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2158\/revisions\/2163"}],"wp:attachment":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/media?parent=2158"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/categories?post=2158"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/tags?post=2158"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}